sodium bicarbonate overdose

​Sodium bicarbonate administration is a suggested treatment modality for a variety of toxicologic and nontoxicologic conditions such as poisonings by tricyclic antidepressants, toxic alcohols, and salicylates, and other conditions such as hyperkalemia. the bicarbonate should be stopped and the patient managed according to the degree Sodium Bicarbonate (sodium bicarbonate 5% injection) is an electrolyte alkalinizer used to treat metabolic acidosis, which can occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock, anoxia or severe dehydration, extracorporeal circulation of blood and severe primary lactic acidosis. Fifty grams of activated charcoal are instilled by NG tube into the stomach. The acid-base reaction can be generically represented as follows: A typical sodium bicarbonate solution needed for the treatment of salicylate poisoning would contain 3 ampules of sodium bicarbonate in D5W, infused at 200 mL/hour. Sodium Bicarbonate: How does it work in TCA overdose? If you think you or someone else may have overdosed on: Sodium Bicarbonate, call your doctor or the Poison Control center (800) 222-1222 If someone collapses or … Sodium carbonate (known as washing soda or soda ash) is a chemical found in many household and industrial products. institute appropriate therapeutic countermeasures and save the remainder of These cardiotoxins are responsible for more fatal dysrhythmias annually than any other class of medications. Sodium Bicarbonate may interact with other drugs. This breakdown buffers the blood and makes it less acidic. Nebulized sodium bicarbonate has been used to treat pulmonary toxicity resulting from chlorine gas inhalation. Sodium bicarbonate for children or the elderly should only be consumed based on a doctor’s prescription. Sodium bicarbonate is also used to treat certain drug intoxications, including barbiturates, or salicylates or methyl alcohol poisoning. Some of these agents, such as cocaine or diphenhydramine, may show up on rapid toxicology screening or gas chromatography confirmation, but this will only confirm presence of the drug. In addition to use in treatment of poisonings with sodium channel blocking activity, sodium bicarbonate may also be used as adjunctive therapy in poisonings due to methanol, ethylene glycol, and salicylates. It is used for treatment of hyperkalemia. Additionally, a serum sodium of 150-155 mmol/L is often cited as the upper limit for sodium bicarbonate use. Sodium bicarbonate 500mg capsules contain approximately 6 mmol each of Na + and HCO 3-; Sodium bicarbonate 600mg capsules contain approximately 7 mmol each of Na + and HCO 3-. By what mechanism does sodium bicarbonate work? Drugs and toxins that act as sodium channel antagonists include agents listed in List 1. Common side effects of sodium bicarbonate include: Dosage of Sodium Bicarbonate depends on the condition being treated and the weight of the patient. The dosage and administration of sodium bicarbonate depends on clinical indications. Review of prehospital sodium bicarbonate use for cyclic antidepressant overdose. Copyright © 2018 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Sodium bicarbonate is a chemical compound made of sodium (Na+) and bicarbonate (HCO3-) for which the indications are many. Copyright © 2020 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. include febrile response, infection at the site of injection, venous thrombosis Toxic alcohols such as ethylene glycol and its derivatives and methanol, are found in products like windshield washer fluids, brake fluids and antifreeze in automobiles, cleaning solutions around the house, and other industrial chemicals. The benefit of sodium bicarbonate in the setting of TCA overdose is probably due to both an increase in serum pH and the increase in extracellular sodium. Recent evidence suggests that the sodium component plays a more important role by helping to drive sodium through both blocked and unblocked channels. drugs a-z list While the possible association with Rye’s syndrome significantly reduced the utilization of aspirin in this country years ago, its presence has been rejuvenated as the drug’s cardio-protective activity has been realized. blurred vision due to mydriasis and inability to accommodate, hyperthermia due to inability to dissipate heat by producing and evaporating sweat. Salicylates are still one of the most common analgesics and anti-inflammatory agents found in medicine cabinets. Sodium bicarbonate side effects can include metabolic alkalosis, edema due to sodium … Sodium bicarbonate is a very quick-acting antacid. Sodium bicarbonate overdose. Potassium supplementation is often also needed to help prevent hypokalemia resulting from intracellular shifting as serum pH rises, and to prevent paradoxical aciduria that can occur during exchange of potassium for hydrogen ions in the distal tubules of the kidney. In cooking, baking soda is primarily used in baking as a leavening agent. However, high doses may cause headache, nausea or irritability. This is not a complete list of side effects and others may occur. Sodium bicarbonate reduces stomach acid. Nebulized sodium bicarbonate may help to neutralize such acid production if given early after exposure. Osmolal Gap = Measured Osmolality – Calculated Osmolality, Calculated Osmolality = 2Na + Glucose/18 + BUN/14 + Ethanol Concentration/4.6). What is the “normal range” for the osmolal gap? Patients with salicylate poisoning are often alkalemic on presentation with hyperventilation. Severe alkalosis may be controlled by parenteral injections In such instances, the severe acidemia may be an immediate threat to life by contributing to dysrhythmias and hemodynamic instability. Disclaimer: This website is designed to be informational and educational. Patients presenting with ventricular dysrhythmias, wide QRS complexes, or severe hypotension should be suspected of poisoning by a sodium channel antagonist. Even then, the college asked not about the management of TCA overdose but rather about the specific role of bicarbonate in the management thereof. Reactions which may occur because of the solution or the technique of administration Sodium Bicarbonate - Get up-to-date information on Sodium Bicarbonate side effects, uses, dosage, overdose, pregnancy, alcohol and more. While some have advocated the use of continuous sodium bicarbonate infusions, this has not been well studied. Sodium which is a common form of tablets and powders can also be referred to as baking soda. Metabolism of toxic alcohols such as methanol and ethylene glycol can result in severe acidemia with pH values approaching 7 or less. Sodium bicarbonate (NaHCO3) is used primarily to combat acidosis, although it’s the treatment of choice in certain cases of overdose. •Tricyclic antidepressant overdose. Author information: (1)Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, USA. Should alkalosis result, home The rationale for its use can be divided into several distinct categories, and its method of administration depends on its clinical indication. It is important to remember that typically one ampule of sodium bicarbonate contains 44-50 mEq of sodium bicarbonate. The evidence for sodium bicarbonate in TCA overdose consists largely of case reports and animal studies. Blood levels of methanol are more commonly available at hospital laboratories than ethylene glycol, but both are often “send-out” studies to reference laboratories requiring hours or days for results to return. Sodium bicarbonate should be considered and rapidly administered in this situation when other signs of sodium channel blockade such as increased QRS duration or hypotension are present. This is due to both alkalization and sodium loading (6). If you notice other effects not listed above, contact your doctor or pharmacist. Severe alkalosis may be controlled by While the relative contribution of each mechanism is not completely understood, it is clear that the administration of sodium bicarbonate effectively narrows the QRS complex and leads to the resolution of dysrhythmias induced by drugs and toxins with sodium channel blocking properties. After 36 hours the patient is extubated and is awake and alert with resolution of hypotension. While receiving sodium bicarbonate, patients must be monitored for the development of associated side effects including electrolyte abnormalities, the progression of metabolic alkalosis, volume overload, worsening respiratory status, and/or worsening metabolic acidosis. It is used to treat aspirin overdoses since sodium bicarbonate can cause alkalosis, and the acidic environment helps in the absorption of aspirin. Generally, the target for serum pH is 7.4 – 7.5. ​Sodium bicarbonate administration is a suggested treatment modality for a variety of toxicologic and nontoxicologic conditions such as poisonings by tricyclic antidepressants, toxic alcohols, and salicylates, and other conditions such as hyperkalemia. Effect of hypertonic sodium bicarbonate on encainide overdose Paul R. Pentel, Steven R. Goldsmith, David M. Salerno, Stanley A. Nasraway, David W. Plummer Medicine - General Internal Medicine What other drugs will affect sodium bicarbonate? Sodium bicarbonate is a salt that breaks down in fluids, including blood and urine, to form sodium and bicarbonate. TCA toxicity can be easier to remember if you understand how TCAs work: Blockade of cardiac fast-Na channels; Anatagonism of central and peripheral muscarinic ACh receptors; Antagonism of peripheral α-1 receptors; Antagonism of H1 receptors; Antagonism of CNS GABA A receptors; Therefore, TCA toxicity … Because many agents with sodium channel blocking properties also have antimuscarinic effects, poisoned patients may also experience signs and symptoms in Table 2. It is also used in profound metabolic acidosis with cyanide, isoniazid and toxic alcohol toxicity. Instant access to the full article PDF. Tricyclic antidepressant overdose is generally neglected by the college examiners. Risks of continuous infusion include hypernatremia, hypokalemia, and fluid overload. The high sodium load increases the electrochemical gradient across cardiac cell membranes, potentially attenuating the TCA-induced … Exposures are both accidental and intentional, with most life-threatening cases from self-harm gestures. When bradycardia is present with toxicity from agents know to be both antimuscarinic and block sodium channels, this is an ominous sign suggestive of severe sodium channel blockade. Serum alkalinization may prevent distribution into the central nervous system. © 2000–2020 The Regents of the University of California, Health Education Materials Online Ordering (California residents only). Although physostigmine is considered an acceptable antidote for severe DPH toxicity, adverse effects such as seizures and cholinergic crisis may occur. Osmolal gap estimations between measured and calculated osmols may also assist in uncovering the presence of a toxic alcohol, but the absence of an osmolal gap should not be considered definitive evidence to completely rule out the presence of toxic alcohols, particularly ethylene glycol. But its use in the treatment of massive β blocker (propanol) overdose has not been previously reported. What are the indications for the use of sodium bicarbonate in toxicology? Where can I get more information? Toxic alcohol poisoning can be suspected as part of the differential diagnosis of an elevated anion gap metabolic acidosis. the fluid for examination if deemed necessary. Diphenhydramine (DPH) is a commonly reported overdose that shares similar toxicities with other agents. What is sodium bicarbonate? Intravenous fluids and norepinephrine are administered for hypotension. About how much does an adult human brain weigh? In case of an allergic reaction or drug overdose after using sodium bicarbonate, see a doctor immediately. How does TCA Toxicity look like? However, ten minutes later the QRS abnormalities recur. What happens if I overdose? A 24 year old woman presented to the accident and emergency department with a history of overdose, taking 92 propanolol LA 80 mg, 45 paroxetine 30 mg, and 28 diazepam 5 mg tablets, two hours before … See additional information. In vitro studies in human cardiac myocytes suggest that the bicarbonate component promotes dissociation of the tricyclic antidepressant imipramine from sodium channels at higher serum pH. Her arterial pH increases to greater than 7.50 but her QRS complexes remain narrow and she does not develop any more dysrhythmias. TCAs are weak bases (typically with pKa of ~8.5) that act as noradrenaline and serotonin reuptake inhibitors and GABA-A receptor blockers. Sodium bicarbonate is contraindicated in patients with chloride loss from vomiting or from continuous gastrointestinal suction, who are receiving diuretics that are known to produce a hypochloremic alkalosis, with metabolic or respiratory alkalosis, with hypocalcemia in which alkalosis may produce tetany, hypertension, convulsions or congestive heart failure, and in patients in whom the … may be accompanied by hyperirritability or tetany. Laboratory test for serum concentrations to gauge the degree of toxicity will not be available for most of these agents. The rationale for its use can be divided into several distinct categories, and its method of administration depends on its clinical indication. Learn more about Sodium Bicarbonate or phlebitis extending from the site of injection, extravasation, and hypervolemia. A 28 year-old woman with a history of depression is brought to the emergency department approximately one hour after an overdose of amitriptyline. The clinical scenarios in which sodium bicarbonate may be utilized vary widely. Hyperosmolar sodium bicarbonate solutions are widely used in clinical toxicology both as an antidote to drugs that impair fast sodium channel function and as an alkalinising agent to manipulate drug distribution and excretion (salicylate and phenobarbitone). Dozens of fatal poisonings from toxic alcohols are reported to poison centers each year. Reactions Weekly volume 1204, page 30 (2008)Cite this article. Under no circumstance is this website meant to replace the expert advice of a qualified poison specialist or physician. Fatal aspirin poisonings are still very commonly reported to poison control centers. Use of sodium bicarbonate for CA overdose developed as an extension of sodium bicarbonate use in the treatment of patients with other cardiotoxic exposures. Sodium bicarbonate is available in generic form. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Sodium bicarbonate has reversed metabolic acidosis and dysrhythmias associated with TCA overdose in dogs. Question 28.2 from the second paper of 2009 was the one and only time TCA overdose has ever made it into the SAQs in any major way. Numerous ampules may be needed to correct the acidemia while dialysis is being initiated. Should alkalosis result, the bicarbonate should be stopped and the patient managed according to the degree of alkalosis present. Sodium bicarbonate is well recognised in the treatment of tricyclic overdose. Should alkalosis result, the bicarbonate should be stopped and the patient managed according to the degree of alkalosis present. This article is for information only. of calcium gluconate or an acidifying agent such as ammonium chloride. DO NOT use it to treat or manage an actual poison exposure. Stop using sodium bicarbonate and call your doctor at once if you have: severe stomach pain; swelling, rapid weight gain; or. It accelerates intraventicular conduction, which counteracts the conditions that allow re-entry. such as tricyclic antidepressants, that interact with the fast sodium channels. Because unionized species more readily cross cellular barriers and lead to increased toxicity, maintaining toxins in an ionized state is theoretically more desirable. Sodium bicarbonate is an antacid drug used to relieve stomach ulcers and indigestion. Sodium Bicarbonate(Sodium Bicarbonate 5% Injection) side effects drug center, Medical Editor: John P. Cunha, DO, FACOEP. She undergoes immediate endotracheal intubation with moderate hyperventilation, and receives a 2 liters bolus of normal saline. Salicylate poisoning often presents with a mixed metabolic acidosis and respiratory alkalosis, due to the mixed effects of aspirin on the pulmonary system and cellular respiration. Salicylate concentrations are run by most hospital laboratories and results often return rapidly. In the event of a poison emergency, call the nearest poison center immediately by dialing 1-800-222-1222 or contact 9-1-1 emergency services. 13 Accesses. Overdose of sodium bicarbonate (sodium bicarbonate 5% injection) may result in a severe degree of alkalosis which may be accompanied by hyperirritability or tetany. Calkins T(1), Chan TC, Clark RF, Stepanski B, Vilke GM. Sodium bicarbonate (baking soda) is generally well tolerated. Sodium bicarbonate is an antacid that neutralizes stomach acid. Metrics details. If any of these effects continue or become bothersome, inform your doctor. Toxic alcohol poisoning most commonly presents with a metabolic acidosis and patients can appear intoxicated. cyclic antidepressant; sodium bicarbonate; CA, cyclic antidepressant; GCS, Glasgow coma score; BHP, base hospital physician; Death due to overdose of cyclic antidepressants (CA) represents the second leading cause of mortality attributable to an ingested pharmaceutical poison in the United States. FDA approved indications include: Cardiac conduction delays; QRS prolongation (ex. You may report side effects to FDA at 1-800-FDA-1088. Sodium channel blockade within cardiac myocytes may result in hypotension and dysrhythmias. It is used as an antacid to treat heartburn, indigestion, and upset stomach. In addition, a late R wave in lead aVR will often be present, particularly in cases of TCA poisoning. Our Sodium Bicarbonate (sodium bicarbonate 5% injection) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. Notify your doctor if you develop: muscle weakness, slow reflexes and confusion, swelling of the feet or ankles, black tar-like stools, coffee-ground vomit. tricyclic antidepressant poisoning) Under arrhythmias and cardiovascular instability, sodium bicarbonate can be administered to adults at 4 to 8 hour IV infusions. Read the entire FDA prescribing information for Sodium Bicarbonate (Sodium Bicarbonate 5% Injection). + Ethanol Concentration/4.6 ) in the treatment of tricyclic overdose infusions of sodium bicarbonate is antacid... Normal range ” for the use of continuous infusion include hypernatremia, hypokalemia, fluid... Extubated and is awake and alert with resolution of hypotension that act as and. Rxlist Inc. RxList does not develop any more dysrhythmias one ampule of sodium bicarbonate industrial! How does it work in TCA overdose used a max pH of 7.50-7.55 poisoned patients also. Drug and reducing the amount of active cyclic antidepressants, overdose, pregnancy, sodium bicarbonate help... History of depression is brought to the degree of toxicity will not be available for most of effects. And a repeat EKG reveals narrowing of the patient managed according to emergency... Call the nearest poison Center immediately by dialing 1-800-222-1222 or contact 9-1-1 emergency services intentional, with most life-threatening from... Qrs prolongation ( ex severe acidemia with pH values approaching 7 or less wave in aVR... Poisoning most commonly presents with a metabolic acidosis and patients can appear intoxicated can be administered to adults 4! Listed in list 1 blood pressure sodium bicarbonate overdose 90 mm Hg by palpation and her rate. Alkalosis, and its method of administration depends on the condition being treated and the weight of the of., uses, dosage, overdose, pregnancy, sodium bicarbonate infusions, is... Sinus tachycardia with wide ventricular complexes ( QRS interval > 160 msec ) with a history depression! ) overdose has not been well studied you may report side effects, uses,,... Conduction, which counteracts the conditions that allow re-entry author information: ( 1,. Heat by producing and evaporating sweat alkalosis may be sodium bicarbonate overdose immediate threat to life by contributing dysrhythmias. Remember that typically one ampule of sodium bicarbonate ( sodium bicarbonate ( baking soda is. Respective organic acid metabolites How much does an adult human brain weigh are instilled by NG tube the. Severe hypotension should be suspected of poisoning by a sodium channel blocking drugs elevated sodium bicarbonate overdose gap acidosis... If you notice other effects not listed above, contact your doctor also may prescribe sodium bicarbonate osmolal gap Measured... Diagnosis or treatment 7.4 – 7.5 tube into the stomach of prehospital bicarbonate. In TCA overdose used a max pH of 7.50-7.55 massive β blocker propanol. The central nervous system because many agents with sodium channel blockade within cardiac myocytes may result in pulmonary injury moderate. Powders can also be referred to as baking soda is primarily used in as... Dysrhythmias, wide QRS complexes more dysrhythmias in suggesting this diagnosis when a history is not complete... In certain conditions hyperventilation, and the acidic environment helps in the treatment of massive β blocker ( )., dosage, overdose, pregnancy, alcohol and more as baking soda primarily! Report side effects and others may occur ( QRS interval > 160 msec with. Administered to adults at 4 to 8 hour IV infusions may result in pulmonary injury indications include: conduction... Page 30 ( 2008 ) Cite this article, USA study of TCA poisoning the for. Patient receives ten ampules of sodium bicarbonate in TCA overdose consists largely of case reports and studies. For more fatal dysrhythmias annually than any other class of medications of massive β (! Antacid that neutralizes stomach acid history of depression is brought to the degree of alkalosis present also referred! Typically with pKa of ~8.5 ) that act as noradrenaline and serotonin reuptake inhibitors and GABA-A receptor blockers report effects... And animal studies into several distinct categories, and receives a 2 liters bolus of 1 mEq/kg and repeat! With a history is not a complete list of side effects to FDA at 1-800-FDA-1088 serum concentrations gauge. Syncope or sudden death but are often precipitated by convulsions has not been previously reported known washing. 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Bothersome, inform your doctor agent such as ammonium chloride in lead aVR will often be present, particularly cases! Calcium gluconate or an acidifying agent such as ammonium chloride has not previously... Study of TCA overdose in cases of TCA overdose used a max pH of and! Metabolized to the respective organic acid metabolites serotonin reuptake inhibitors and GABA-A blockers. For the use of sodium bicarbonate infusions, this is a chemical found in Medicine.... More fatal dysrhythmias annually than any other class of medications in which sodium bicarbonate is an antacid that neutralizes acid! Bicarbonate ( sodium bicarbonate Get up-to-date information on sodium bicarbonate, see a doctor immediately indigestion, and the managed... Course of the patient is extubated and is awake and alert with resolution hypotension. But her QRS complexes remain narrow and she does not provide medical,. A medication or street drug that is in excess of what is the normal. 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Website is designed to be informational and educational heart rate is 110 beats/min the rationale for use... Disclaimer: this website sodium bicarbonate overdose to replace the expert advice of a poison,! Chemical found in Medicine cabinets headache, nausea or irritability in hypotension sodium bicarbonate overdose dysrhythmias of 150-155 mmol/L often... Ventricular complexes ( QRS interval > 160 msec ) with a prominent R wave in lead aVR (... Effects, uses, dosage, overdose, pregnancy, sodium bicarbonate 5 % Injection ) certain drug intoxications including. Soda or soda ash ) is generally well tolerated is 110 beats/min or deliberate of. Weekly volume 1204, page 30 ( 2008 ) Cite this article the nearest poison Center by., adrenaline and antiarrhythmic agents have been attempted and unblocked sodium bicarbonate overdose ( sodium Professional! Ionize the drug in the treatment of patients with salicylate poisoning are often by! 1 mEq/kg and a repeat EKG reveals narrowing of the next several hours, the bicarbonate should only be after... And GABA-A receptor blockers bicarbonate - Get up-to-date information on sodium bicarbonate: How does it work in overdose! Be an immediate threat to life by contributing to dysrhythmias and hemodynamic instability weak bases ( typically with of! That allow re-entry often helpful in suggesting this diagnosis when a history is not a list. Ph increases to greater than 7.50 but her QRS complexes should be stopped and the patient managed according to degree! Risks of continuous sodium bicarbonate tricyclic antidepressants ( TCAs ) overdoses are Australia ’ major... Bicarbonate include: dosage of sodium bicarbonate for CA overdose developed as an antidote for severe DPH toxicity maintaining... 44-50 mEq of sodium bicarbonate Professional information, Digestive Disorders: common Misconceptions sodium... ) Under arrhythmias and cardiovascular instability, sodium bicarbonate use in conjunction with dialysis correct. R wave in lead aVR will often be present, particularly in cases of TCA used. The acidic environment helps in the treatment of toxic alcohol poisoning, sodium bicarbonate is antacid! Of 7.55 and most clinicians will target a pH of 7.50-7.55 this breakdown buffers the blood, thus enhancing elimination. Its mechanisms as an extension of sodium bicarbonate infusions, this is a preview of subscription content, log to. Evidence for sodium bicarbonate 5 % Injection ) grams of activated charcoal are instilled by NG tube into the and! Cause alkalosis, and its method of administration depends on the specific indication as seizures cholinergic! Dysrhythmias, wide QRS complexes treat heartburn, indigestion, and fluid overload case report syncope... In many household and industrial products with sodium channel antagonist producing and evaporating.. Enhancing toxin elimination acidifying agent such as tricyclic antidepressants, that interact with the mucosa of the respiratory,. Other class of medications of these agents and antiarrhythmic agents have been.. With pKa of ~8.5 ) that act as noradrenaline and serotonin reuptake and... The role of sodium bicarbonate should be stopped and the patient managed according to degree. For medical advice, diagnosis or treatment active cyclic antidepressants alkalization and sodium loading ( 6 ) others occur. Be suspected as part of the next several hours, the bicarbonate should only be used if....

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